Shortening "long face" - what are the options?

[rylai]

Hi,

I am 21, male. Currently I am in treatment because of my dysgnathia. My diagnosis is - maxillary retrognathia, narrow upper palate, laterognathia (1mm). My occlusion is far from ideal, but not an under- or overbite. I have a severe edge-to-edge-bite and a onesided crossbite, and some frontal tooth crowding in the maxillary palate.

Getting SARPE soon, then later in the year double jaw surgery. It will probably involve a CCW rotation of the maxilla and maybe some advancement of both jaws sagitally.

I have a bad faceshape IMO - my facial thirds are unbalanced, because my lower third is dysproportionately longer than the other two. The space between nose and upper lip (philtrum) is too long, it is /not/ mandibular or chin excess. I, however, do not possess a gummy smile. Possibly because of the maxillary retrognathia? My philtrum is around 22-25mm long (male median is 16mm+-/2.56mm) - too long, and I have almost no visible upper lip. It's more like a concave, inverted upper lip. My midface is ok. So it's not classic unattractive long midface case.

I have often read that shortening the midface (beginning of the nose to glabellum) is impossible except with maybe a LeFort III, with likely disastrous results. But can you shorten the lower third to harmonize the facial ratios? I have read of maxillary impaction, but the probably I see here is that I do not have a gummy smile. Also, would an impaction for that particular reason not result in excess soft tissue or will the face adapt to it?

Will a CCW rotation of the maxilla result in a similar effect (shortening), because I've read that in some forums, but I can't imagine how that should happen.

When I morph myself with a good portion of face height in the lower third (philtrum) removed, probably around 8mm, my face looks way more balanced, even attractive. Is this possible with double jaw surgery involving impaction and some removal of excess philtral skin? Should I ask my surgeon about this?

Best wishes and thanks for your thoughts!

[Bconnellyguitar]

Honestly, we'd have to see a picture of your mid/lower face to comment, I think. You actually sound fine to me, from your description. It's time to worry when your MID face is long and you have a gummy smile. But I'd still have to see a photo. I think you're fine as is to be honest, at least aesthetically.

[Anna5]

Hello Rylai,

I think I cannot help you, but I sincerely think that you are looking fine. I see your concerns, but to me they are only visible if you look for them (draw lined etc.).To the common eye, you absolutely look normal. I would say, think twice about everything. But is you feel that correcting this all makes you happy, definitely go for this! I wish you good luck with your treatment.

[rylai]

Hi anna5,

thanks for you response.

I'm already in treatment and I will be getting double jaw surgery no matter what. Especially because of the sagittal deficit (see profile). It might not be noticeable as in a majority of strangers could pinpoint what is wrong with your face but more so in a sense that it significantly detracts from my facial aesthetics and is detrimental to attraction, although more on a subconscious level.

[mmkay]

I think you are expecting too much of the people on this forum, we ain't surgeons :/ One obvious comment, if you don't have a gummy smile an impaction would usually result in your upper lip sagging right down over your teeth (old person look). If you don't fit one of the common profiles for jaw surgery, maybe you need a consult with a maxfac that specialises in people with facial deformities.

And yeah, if you had successful surgery people would think 'you look better' without being able to put their finger on it.

[rylai]

No,

I don't fit into the classic profiles. I don't have an under- nor overbite either, just edge-to-edge.

Seems like both jaws are recessed. I have a smaller incisal angle, higher cervicomental angle and an extreme anterior inclination of the mandible, which I forgot to add.

Sorry if I was to specific. I seek help everywhere I can and there might be someone here highly knowledgeable about it.

I don't had time to ask those very specific questions to my surgeon, because the double jaw surgery is still months away and planning didn't even start. I will ask then, obviously.

But until I don't have answers I'm very nervous about it.

[Norrie]

First of all, I think that you're a good looking guy as things stand right now. One of my doctors has a similar face shape from his nose to mouth, and I totally have an inappropriate crush on him (in part, because of how much I like his mouth).

I honestly don't know what the limits of surgery are. Would this fall more under a plastic surgeon's realm?

I think that you're being to hard on yourself, but no matter what, good luck.

[rylai]

Well, as far as I know, plastic surgery often involves the alteration/manipulation of soft-tissue. Shortening the face like in the picture above, I'm certain, would require work done on both soft tissue and bone structure. I don't know... i'm not a doctor.

[ST24085]

Honestly man, I think you look fine. Your front view looks absolutely fine and I can just barely tell about what you're saying about your profile now that you've mentioned it. But it's minor; I've seen a lot worse on these forums.

If you're going after a major aesthetic result I fear you may be pissing up a rope, so to speak. However I can attest to it if you're going through with all this for functional reasons. I am in a similar situation. I have a significant asymmetry, 5 mm class iii crossbite, my upper jaw is smaller by that amount and as such, my teeth barely work. I require double jaw at the very minimum, and perhaps SARPE. They're lining all my teeth up first to see.

I'm not entirely convinced that my face is going to change very much because my ortho has been amazed on multiple occasions how well I hide my poor bite. The way I'm looking at it, if I somehow get a positive aesthetic result from all this, great, but what I'm really looking for is being able to chew food properly for the first time in my life. And if that's all I get out of this ordeal I'll be happy.

But that's just my two cents. Good luck man!

[rylai]

hi ST24085!

frontal view it's one of my better photos. there are a lot worse. im just too vain to post them here. it is really noticeable. obviously, not in that extent, that people would say "look at this freak", but to that extent that its detrimental to my facial esthetics.

to be honest, i only do it for esthetic purposes. it was my motivator behind seeking treatment. however, i have poor bite like i said, unilateral crossbite and edge-to-edge bite, crowding. which is why its paid by insurance.

and i've crossed a point of no return. I'm in the middle of the treatment and I can't quit without major financial burden, and i don't intend to. I too had SARPE just 5 weeks ago! my upper palate was noticeably widened.

you're underestimating the power of orthognathic surgery. beauty is about millimetres, i've seen a friend of mine looking SO MUCH better with a simple genioplasty of 5mm anterior projection. it's like two different worlds. in an ideal treatment he would have gotten BSSO+genio to fix his mandibular recession, and this would've been awesome, but even the genio alone gave a huge improvement.

also, beauty is not about what we can consciously perceive - it's highly subconscious. what exactly makes an attractive person attractive? what makes an ugly person ugly? any person could barely tell, except it has some totally deviant features like a huuuge nose or other anomalies. but why some people just look plain they can never identify, they just look like that to them.
you might "barely notice" my convex shaped profile, but females and males alike will subconsciously deem this as significantly less attractive. it's just the way the world is.

I'm 100% positive that my sagittal defiency will be vastly improved to the point it will be close to the ideal. The fear I just have is an inadequate fix of the vertical dysharmony.

[ST24085]

You're probably right. A few mm can make a large difference. You've had SARPE already? How's it been so far? How much are they going to expand?

Sounds like you're pretty confident with your decision so that's good. I hope it turns out for you!

[rylai]

I had around 4.5mm expansion I guess (22x turns of the screw), but the interincisal tooth gap itself was considerably smaller, maybe around 2.5mm at most. I don't know why.

Now it's closed again, but you can notice it. Definitely.

[ST24085]

Wow that's it eh? They're lining my teeth up before they decide if I only need double jaw or both it and SARPE. They said I need 5 mm expansion which is the limit for lefort. Seems like a more stable result would be achieved from doing both.

So how long total did it take for the gap to close?

[rylai]

it was closed 2 weeks after stop

teeth move quickly in my case i suppose

[Nat123]

I think your a good looking guy already and wouldn't change of thing. You've probably been told that many times already, and I know its difficult to convince anyone if they fixate on one slightly imperfect aspect of their face. I tell you my own experience. I always had a small jaw and though it made me very boyish looking and unattractive to women. I never did anything about it because it was cosmetic, and had very nice friends in my life the way I was. I developed sleep apnea, and decided to go through with a BSSO procedure to open my airway which as a side effect would improve my profile. It worked, and I do look technically better, and honestly some types of people are more attracted to me than before...but honestly they are the wrong people for me. The kinds of people who used to like easily me, do not have the same attraction at least on first impressions. I regret that part, but have to live with it. Be very wary about changing something minor on your face and think think it will make things better...it may make them much worse for your particular personality. If you have a minor imperfection, OWN IT, and make it a unique and desireable thing people want. Your personality counts much more in the end and I think people respect you more if you don't dwell on it, and have a good personality despite the imperfection...that is very attractive actually to many people...and most importantly the BEST people as well.